Weight loss after Swedish Adjustable Gastric Banding: relationships to insulin resistance and metabolic syndrome

Background:The metabolic syndrome is a cluster of cardiovascular risk factors (central obesity, hypertension,dyslipidemia, disturbance in glucose metabolism) associated with insulin-resistance. The cluster of risk factors defining the metabolic syndrome increases cardiovascular risk more than each single component. The aim of the present longitudinal study was to evaluate the relationship between weight loss and changes in insulin-resistance and in the prevalence of the metabolic syndrome 1-year after SAGB implantation. Methods: 51 premenopausal severely obese women (mean age 35.2±8.8 years, BMI 43.3±6.9) were enrolled. As a control group, 51 premenopausal nonobese women (BMI<30) were enrolled. All obese subjects underwent successful implantation of the SAGB via videolaparoscopy. In all subjects insulinresistance was estimated by HOMA index and metabolic syndrome was defined according to the criteria of the European Group for the Study of Insulin Resistance. Results: HOMA (4.2±2.0 vs 1.9±0.8, P<0.001) and the prevalence of the metabolic syndrome (58.8% vs 7.8%, P<0.001) were significantly higher in obese than non-obese women. 1 year after SAGB, BMI significantly decreased from 43.3±6.9 to 34.5±7.4 (P<0.001). HOMA index showed a significant dramatic breakdown (4.2±2.0 vs 2.4±1.0, P<0.001). The prevalence of the metabolic syndrome declined significantly (58.8% vs 21.6%, P<0.001). Conclusion: Our study shows that in severely obese women, insulin-resistance and the prevalence of the metabolic syndrome significantly decrease 1 year after SAGB. Our findings indicate that SAGB could be a useful tool to reduce the global cardiovascular risk in severely obese people and to improve their long-term prognosis.     

Metabolic syndrome in severely obese patients

Background: The authors assessed the prevalence of diabetes, hypertension, dyslipidemia and metabolic syndrome in patients with a high degree of obesity. Methods: A retrospective investigation was planned in a cohort of obese patients with a wide range of body mass index (BMI) referred to a large University Hospital for weight loss. Results: An increase in prevalence of diabetes and hypertension with increase in the degree of obesity was observed, while the prevalence of dyslipidemia and metabolic syndrome appeared to be independent of the BMI values. Conclusion: In severely obese patients a still unknown factor which affects differently glucose and lipid metabolism cannot be excluded.     

Relationships of serum leptin to clinical and anthropometric findings in obese patients

Background: The authors evaluated the relationship between leptin and the clinical, anthropometric and metabolic variables connected to the metabolic syndrome in obese individuals. Methods: A large group of patients with different degrees of obesity was investigated: body mass index (BMI) values, serum leptin, fasting glucose and insulin, triglycerides and HDL-cholesterol concentrations, insulin resistance index and blood pressure were measured. Results: On multiple regression analysis, serum leptin levels appeared to be positively correlated to the BMI and to the serum HDL-cholesterol concentration. Principal component factor analysis revealed three factors, explaining 61.3% of the total variance of the sample. General features of these factors were: factor 1 - BMI values and serum leptin and fasting glucose concentration; factor 2 - systolic and diastolic blood pressure and serum triglycerides and HDL-cholesterol concentration; factor 3 - fasting serum insulin concentration and insulin resistance index. Conclusions: In obese subjects multiple factors underlie the metabolic syndrome and therefore more than one mechanism may account for the clustering characteristics. In obese patients leptin loads only one factor, and therefore leptin does not appear to be a key feature in the metabolic syndrome. On the contrary, multiple correlation and factor analysis data give rise to the hypothesis that in obese patients, leptin may play a protective role against cardiovascular risk.     

Serum Hepatocyte Growth Factor Concentration in Obese Women Decreases after Vertical Banded Gastroplasty

Background: Human obesity is associated with increased serum hepatocyte growth factor (HGF) concentration. This study examines whether reduced body fat mass after vertical banded gastroplasty (VBG) is associated with a decrease in serum HGF concentration. Methods: Serum HGF concentration and body weight, BMI, body fat mass, blood pressure, serum leptin, insulin, triacylglycerol, and cholesterol concentrations were studied in 10 obese women before and 1 year after VBG. 10 lean, healthy women were used as controls. Results: Obese women showed significantly higher serum HGF concentration than control (lean, healthy) subjects. The mean serum HGF concentration decreased significantly 1 year after VBG, but did not reach the value observed in lean women. After VBG, BMI, body fat mass and serum HGF had similar patterns of decrease. Moreover, serum HGF concentration was positively correlated with both BMI (r=0.6, P<0.01) and body fat mass (r=0.6, P<0.01). Before surgery in obese women, elevated blood pressure was observed, which decreased after VBG. Linear regression analysis between blood pressure and serum HGF concentration using all subjects, showed no correlation between either systolic blood pressure and serum HGF concentration (r=.15, P=NS) or between diastolic blood pressure and serum HGF concentration (r=0.1, P=NS). Insulin resistance index (HOMA score), serum leptin, insulin and triacylglycerol concentrations decreased 1 year after VBG. However, serum cholesterol concentration did not change significantly. Conclusions: These results indicate that VBG results in a reduction in circulating HGF concentration. The reduced body fat mass may contribute in part to the decrease of serum HGF concentration after VBG. Because elevated serum HGF concentration may contribute to the progression of atherosclerosis, the decrease in serum HGF concentration after VBG may be beneficial for obese subjects.     

Smaller Hip Circumference is Associated with Dyslipidemia and the Metabolic Syndrome in Obese Women

BACKGROUND: There is great need for simple anthropometric measures that predict risk. The authors explored the relationship between body composition measures and features of the metabolic syndrome (MtS) in women aged between 20 and 50 years with class I obesity. METHODS:This is a cross-sectional study of 49 obese (BMI 30-35) women recruited into a weight management randomized trial. An analysis was conducted of the baseline weight, anthropometric measures, skin-fold thickness, bioelectrical impedance, whole body dual-energy x-ray absorptiometry (DEXA), and their relationships with the features of the MtS. RESULTS: All women but one (n=48) had a population risk waist circumference of >88 cm. 16 of the 49 (33%) fulfilled the criteria of the metabolic syndrome. Simple anthropometric measures provided the strongest correlations with the presence of the MtS. Cut-off values were selected using receiver operator characteristics. Waist circumference of >100 cm and hip circumference <115cm was associated with odds ratios of 5.2 (95% CI, 1.4-20) and 12.3 (95% CI, 3.0-51) respectively for the MtS. Regional DEXA analysis showed that lower leg fat mass rather than fat-free mass was associated with the MtS. The dyslipidemia of the MtS was associated with a lower leg fat mass, while higher HbAlc levels and HOMA, an indirect measure of insulin resistance, were seen with increased trunk fat. Percentage fat as measured by skin-fold thickness and bioelectrical impedance were not related to any features. Women with the metabolic syndrome were found to have lower bone mineral content as measured by DEXA. CONCLUSION: Weight distribution is highly predictive of metabolic risk. Smaller hip and larger waist circumference provided independent effect. BMI adjusted anthropometric measures may be of value.     

Metabolic Profile in Severely Obese Women is Less Deteriorated than Expected when Compared to Moderately Obese Women

Background: Obesity is well known to be associated with an increased prevalence of metabolic complications. Severe obesity is thus expected to have more important alterations of the metabolic profile than moderate obesity. This study aimed to compare the metabolic profile of pre- and postmenopausal severely obese women with moderately obese women. Methods: First, the metabolic profile of pre- (n=165) and postmenopausal (n=43) severely obese women (body mass index (BMI) ≥40 kg/m²) was compared to that of pre- (n=52) and postmenopausal (n=35) moderately obese women (BMI of 30-40 kg/m²). Thereafter, pre- and postmenopausal severely obese women were divided into two subgroups according to the presence/absence of a dysmetabolic profile. We used for comparison, a group of pre- and postmenopausal moderately obese women without a dysmetabolic profile. Results: The metabolic profile of pre- and postmenopausal severely obese women was less deteriorated than expected when compared to moderately obese women. Moreover, severely obese women with or without a dysmetabolic profile displayed comparable or even lower plasma levels of cholesterol, HDL and LDL-cholesterol, and a lower cholesterol/HDL-cholesterol ratio than moderately obese women (P≤0.05). After menopause, the metabolic profile of severely obese women, dysmetabolic or not, was similar to that of moderately obese women. Blood pressure was, however, higher in severely obese women compared to moderately obese women, only before menopause (P≤0.0001). Conclusion: These results indicate that despite their large accumulation of adipose tissue, most of the severely obese women had a metabolic profile less deteriorated than expected, when compared to moderately obese women.     

肥胖、瘦素与多囊卵巢综合征

为探讨肥胖、瘦 素（ｌｅｐｔｉｎ） 与多囊卵巢综合征（ Ｐ Ｃ Ｏ Ｓ）的关系,本研究观察 ４０ 例 Ｐ Ｃ Ｏ Ｓ 患者体重指数（ Ｂ Ｍ Ｉ）、腰围／臂围比值（ Ｗ Ｈ Ｒ）、血 ｌｅｐｔｉｎ 水平,其与血性激素和口服糖耐量试验（ Ｏ Ｇ Ｔ Ｔ）中胰岛素（ Ｉｎｓ）浓度的关系,并与 １６ 例正常妇女进行对照。结果显示, Ｐ Ｃ Ｏ Ｓ患者有高雄激素高胰岛素血症, Ｗ Ｈ Ｒ 和血 ｌｅｐｔｉｎ 浓度升高,我们认为肥胖和 ｌｅｐｔｉｎ 水平的升高与 Ｐ Ｃ Ｏ Ｓ密切相关。     

Obesity, low testosterone levels and erectile dysfunction

Obesity is an important risk factor for many common diseases including cardiovascular disease (CVD), type 2 diabetes, cancer and erectile dysfunction (ED). Adipose tissues produce a number of adipokines and cytokines, which affect endothelial and metabolic function resulting in insulin resistance and the metabolic syndrome (risks factors for CVD). Both ED and metabolic syndrome improve with a reduction in body mass index (BMI). The relationships among obesity, metabolic syndrome, ED, sex hormone-binding globulin (SHBG) and serum total and free testosterone levels are complex and often confusing to the physician. It is known that BMI is inversely proportional to serum total testosterone concentrations; low serum SHBG levels in obesity contribute to the low serum total testosterone. Recent studies show that BMI is also inversely proportional to free testosterone concentration. The characteristic low serum testosterone concentrations observed in obese men are also present in men with the metabolic syndrome and type 2 diabetes mellitus. A small proportion of men with ED have hypogonadism; however, the proportion increases if these men are obese with manifestations of the metabolic syndrome or type 2 diabetes mellitus. ED is a common symptom in patients with type 2 diabetes who also have low testosterone levels. This review describes the relationships between low serum testosterone concentrations and ED in obese patients and those with metabolic syndrome and type 2 diabetes mellitus.     

The Effect of Loss of Excess Weight on the Metabolic Risk Factors after Bariatric Surgery in Morbidly and Super-Obese Patients

BACKGROUND: Changes in metabolic risk factors such as dyslipidemia and hyperinsulinemia as well as levels of sex hormones and leptin were studied in morbidly obese (MO) and super-obese (SO) patients during excess weight loss (EWL), separately in males and females. METHODS: In this prospective clinical intervention study, 431 patients were included (361 females and 70 males). There were 217 patients with MO (BMI 40-49.9 kg/m2) and 214 patients with SO (BMI > or =50 kg/m2). All patients underwent restrictive bariatric operations. Metabolic parameters (lipids, insulin, leptin, hepatic transaminases, uric acid, and sex hormones) were measured before obesity surgery and at defined postoperative points of EWL (25%, 50%, 75% and 100%). RESULTS: Successful weight reduction of 25% EWL was achieved by 94% of patients at 2 months. With this moderate EWL, most of the patients already improved their risk profile considerably, including normalization of insulin levels. Additional EWL led to a further amelioration of risk profile in all patients, including normalization of triglyceride levels. Male MO and SO patients had a worse metabolic situation preoperatively and a greater benefit after weight loss. Even though SO patients did not lose as much excess weight as MO patients, they did profit comparably. CONCLUSION: Bariatric surgery is a valuable tool not only to reduce excess weight in severely obese patients but also to improve the metabolic risk profile within a short time-frame. This benefit is most pronounced in high-risk males.     

Testosterone and obesity in men under the age of 40 years

The study assessed anthropometric and laboratory variables, in particular testosterone (T) in a group of obese men of <40 years. Of 60 men with a body mass index (BMI) of >27 kg m^?2, 34 met the criteria of the metabolic syndrome (MS). Twenty men <40 years (with a BMI <25 kg m^?2) were studied for comparison. It was found that with increasing BMI, levels of serum leptin, triglycerides, insulin, the ratio high‐density lipoprotein (HDL) cholesterol/low‐density liporotein (LDL) cholesterol, the waist circumference (WC), the area of visceral fat and systolic/diastolic blood pressure were higher, whereas insulin sensitivity (HOMA) and serum T were lower. Obesity (BMI 27–30 kg m^?2) was associated with a decline in plasma T, but not with a decline in plasma sex hormone‐binding globulin (SHBG). The latter was the case in more severe obesity (>30 kg m^?2) qualifying as MS. In patients with MS, 58% variability of T levels could be predicted by combination of independent factors – SHBG, ratio LDL/HDL, insulin and leptin. On the other hand, in men with MS, 80% variance of concentrations of SHBG were predicted by triglycerides, HDL, glucose, leptin and surface of visceral adipose tissue. It is concluded that plasma T is significantly correlated with a number of features of the MS and, therefore, plasma T could serve as a marker of the MS.     

Waist Circumference is Useless to Assess the Prevalence of Metabolic Abnormalities in Severely Obese Women

BACKGROUND: The present retrospective study aims to provide additional evidence supporting the fact that waist circumference, in severe obesity, is not a good clinical marker to identify individuals with the metabolic syndrome or an altered metabolic profile. METHODS: Relationships between waist circumference and metabolic profile of pre- (n=165) and postmenopausal (n=43) severely obese women were compared to associations observed in pre- (n=52) and postmenopausal (n=35) moderately obese women. RESULTS: Results showed that abdominal obesity assessed by waist circumference was more highly correlated with fasting glycemia, HDL-cholesterol and the cholesterol/HDL-cholesterol ratio in moderately than in severely obese women, before menopause. After menopause, waist circumference was not a valuable predictor of metabolic abnormalities in both groups. Moreover, when waist circumference was included as a criterion of the metabolic syndrome (as defined by the NCEP ATP III guidelines) in severely obese women, the prevalence of this metabolic condition was over-estimated by 72%. CONCLUSION: These results emphasize the uselessness of waist circumference to assess the prevalence of the metabolic syndrome or an altered metabolic profile in severely obese women.     

Decrease in Circulating Glucose, Insulin and Leptin Levels and Improvement in Insulin Resistance at 1 and 3 Months after Gastric Bypass

Background: Hyperglycemia, insulin resistance and hyperleptinemia are some of the consequences of obesity. Gastric bypass for morbid obesity provides gastric restriction with decreased energy absorption. To confirm and extend previous reports in the literature, we evaluated the plasma glucose, serum insulin and leptin and insulin resistance of patients preoperatively and 1 and 3 months after Roux-en-Y gastric bypass (RYGBP). Methods: We determined body mass index (BMI), plasma glucose (glucose-oxidase method), serum leptin (immunoassay) and insulin (chemiluminescent immunometric assay), and insulin resistance index (IRI) by Homeostasis Model Assessment (HOMA) of 20 patients with morbid obesity both preoperatively and 1 and 3 months after RYGBP. Results: Patients showed a mean decrease in weight of 8 kg/month. Glycemia was above reference levels in 65% of the preoperative patients but dropped significantly 1 month postoperatively, serum insulin and leptin levels and the HOMA index also decreasing significantly in the same period. The percentage of patients with preoperative elevated serum insulin and leptin relative to reference levels decreased significantly following RYGBP. We also observed a weak but significant correlation between BMI and glucose, BMI and insulin, and leptin and insulin. Conclusions: The beneficial effects of bariatric surgery are already noticeable 1 month postoperatively, the reduction in insulin levels being more important for leptin reduction than decreased BMI. Leptin appeared to be subject to multifactorial control and showed a larger reduction than body weight.     

Impact of Laparoscopic Roux-en-Y Gastric Bypass on Metabolic Syndrome, Inflammation, and Insulin Resistance in Super Versus Morbidly Obese Women

Background  Although Roux-en-Y gastric bypass (RYGBP) is one of the preferred bariatric procedures in obese individuals, the efficacy of this procedure in the setting of super-obesity [body mass index (BMI) ≥50] is unclear. The aim of this study was to compare the efficacy of laparoscopic (L) RYGBP to reverse metabolic syndrome, inflammation, and insulin resistance in super-obese women compared to morbidly obese women. Methods  Seventy-three consecutive women were enrolled in this prospective study. Anthropometric, metabolic, and inflammatory biological parameters were assessed in 18 super-obese and 55 morbidly obese women before LRYGBP and 1 year after surgery. Metabolic syndrome was diagnosed according to the International Diabetes Federation definition. Results  Before surgery, super-obese women had a higher BMI, fat mass, blood insulin, and HOMA1-IR than morbidly obese women. Both groups had similar serum levels of C-reactive protein and orosomucoid. The incidence of metabolic syndrome, type 2 diabetes, and increased liver enzymes was comparable in the two groups. One year after LRYGBP, metabolic syndrome, type 2 diabetes, metabolic and inflammatory biological parameters were improved in the whole study population. A similar degree of improvement was observed in super-obese and morbidly obese women, although BMI and fat mass were persistently higher in super-obese patients. Conclusions  One year after surgery, LRYGBP was equally effective at reversing metabolic syndrome, inflammation, and insulin resistance in morbidly obese and super-obese women.     

Recovery of insulin sensitivity in obese patients at short term after biliopancreatic diversion

OBJECTIVE: To gain insight into the specific mechanisms by which biliopancreatic diversion (BPD) can improve insulin action. MATERIALS AND METHODS: Nondiabetic severely obese patients (n=20) undergoing BPD were included. Waist-to-hip ratio and serum concentration of glucose, insulin, and leptin were determined before, at 4-day, and at 2 months after the operation. Insulin sensitivity was calculated according to the homeostatic model assessment (HOMA IR). RESULTS: A marked increase of insulin sensitivity was observed by the fourth day after the operation; at the second postoperative month, when body weight was still in the obese range and the food intake was substantially similar to the preoperative one, a further improvement of insulin action towards normality was found. Moreover, before BPD HOMA IR data were independently correlated both to BMI and waist-to-hip ratio values, whereas at 2 months after the operation data were in positive correlation only with the BMI. DISCUSSION: In obese patients, BPD seems to achieve recovery of insulin sensitivity by specific mechanisms independent of weight loss: the main causes of this sharp improvement might be both the intramyocellular fat depletion and the interruption of enteroinsular axis.     

Hyperuricemia: a Reality in the Indian Obese

Hyperuricemia is known to be associated with obesity and metabolic syndrome. The aims of this study were to evaluate the prevalence of hyperuricemia in the Indian obese population and to determine if a correlation exists between hyperuricemia, body mass index, waist circumference and components of metabolic syndrome. This was a retrospective observational study. Four hundred nine obese patients were included. Anthropometric parameters were recorded. Prevalence of type 2 diabetes mellitus (T2DM), hypertension and dyslipidemia were recorded. Uric acid levels were measured in all patients. Hyperuricemia was defined as serum uric acid levels greater than 6 mg/dl. The population studied had a median body mass index (BMI) of 44.14 kg/m(2) (range 28.1-88.2 kg/m(2)) and a median age of 41 years (range 18 to 75 years). Overall prevalence of hyperuricemia was 44.6 %. Thirty-four percent in the BMI range of 28-35 kg/m(2) and 47 % of patients with a BMI of >35 kg/m(2) had hyperuricemia. The incidence of hyperuricemia in males was 50 vs 21.7 % in females. Of patients in the hyperuricemia group, 47.3 % had hypertension as compared to 37 % in the normouricemic group. Dyslipidemia was seen in 7.3 % of hyperuricemic patients as compared to 5.8 % of the normouricemic subjects. The prevalence of T2DM was comparable in both the groups. The Indian obese population has a significant high prevalence of hyperuricemia; the incidence of hyperuricemia in male patients was greater than in female patients. Central obesity had no direct link to hyperuricemia. There was no significant correlation between the occurrence of T2DM and dyslipidemia and hyperuricemia. Hypertension was the only comorbidity seen to occur in conjunction with hyperuricemia.     

The Relationship between Childhood Parental Loss and Metabolic Syndrome in Obese Subjects

The increasing global trend of obesity is a fundamental contributor to the growing prevalence of metabolic syndrome, a cluster of medical abnormalities including impaired glucose and lipid metabolism, obesity and hypertension. Results from animal and human investigations have shown that early life stress can result in weight gain and metabolic changes. Our aim is to investigate whether a particular type of an early adverse event, i.e. parental loss during childhood, is associated with the development of metabolic syndrome in severely obese subjects. One hundred thirty‐five consecutive obese patients who were seeking bariatric surgery were assessed for metabolic syndrome according to the Adult Treatment Panel (ATP) III criteria. Information regarding the experience of parental separation or bereavement before the age of 17 was collected with the use of a semi‐structured interview. In our population, 31.1% of the subjects met the criteria for metabolic syndrome. No significant differences in demographic factors, health habits or psychiatric diagnosis were found between patients with and without coexisting metabolic syndrome. After adjusting for age and gender, multivariate logistic regression analysis revealed that both childhood loss of a parent and a body mass index (BMI) value greater than 50 were significant predictors of metabolic syndrome. This study provides preliminary evidence linking childhood parental loss to risk factors for the development of metabolic syndrome. Copyright © 2011 John Wiley & Sons, Ltd.     

Effect of Abdominal Obesity on Insulin Resistance and the Components of the Metabolic Syndrome: Evidence Supporting Obesity as the Central Feature

Background: Metabolic syndrome includes abdominal obesity, diabetes type 2, hypertension, dyslipidemia, derangements of fibrinolysis, and atherosclerosis. Since abdominal obesity is one of the major components of the insulin resistance syndrome (IRS), an attempt was made to evaluate the interrelationships between the magnitude of obesity and the components of the syndrome. Methods: A cross-sectional study of 123 subjects with type 2 diabetes, of whom 31 were normal body weight and 92 had varying degrees of obesity was conducted. The participants were investigated in terms of clinical and laboratory findings of IRS. Fasting and 30-min (early) plasma glucose and serum insulin excursions in response to oral glucose challenge (75 g) were determined. The peripheral and hepatic insulin resistance (insensitivity) was calculated by homeostasis model assessment (HOMA). Results: Clinical and biochemical findings were compared with the components of the IRS, and demonstrated that a rise in fasting as well as 30-min insulin secretion increases as abdominal body fat (obesity) increases. There was also a significant and proportional correlation between the magnitude of abdominal obesity and the components of metabolic syndrome. Conclusion: Abdominal adiposity appears to have a pivotal role in the development of IRS.     

Waist Circumference and Related Anthropometric Indices Are Associated with Metabolic Traits in Severely Obese Subjects

Increased waist circumference (WC) and related anthropometric indices have been shown to be, independently of body weight and body mass index (BMI), associated with adverse metabolic traits in many populations. It is unknown, however, whether WC also predicts adverse metabolic traits in severely obese subjects displaying a BMI greater than 35 kg/m². To address this question, we analyzed a dataset including 838 severely obese patients (597 women, BMI 44.6?±?6.2 kg/m²; 241 men, BMI 44.3?±?5.7 kg/m²). Body weight, height, WC, hip circumference, and blood pressure were measured in all subjects along with the following metabolic blood markers: fasting glucose, insulin, glycolized hemoglobin levels, triglycerides, total cholesterol, low- and high-density cholesterol, and uric acid. Multivariate regression analyses indicated that WC as well as related anthropometric indices, in particular those accounting for subjects’ height, were associated with many metabolic variables independently of body weight and BMI. In general, height-adjusted WC indices were more closely associated with metabolic traits in women than in men. Collectively, our findings suggest that body fat distribution also plays an important role in determining metabolic traits in severely obese subjects and that WC represents a valuable marker of abdominal/visceral obesity in this population.     

Evaluation of renal function and proteinuria based on mass health examinations in young Japanese obese adults

Background  Although obesity is recognized to be a risk factor for chronic kidney disease (CKD), few studies have reported the association between obesity and CKD in the young population. We investigated the relationship between obesity and renal function including proteinuria in young Japanese. Methods  This cross-sectional study consisted of 16,031 men and 5,746 women aged from 20 to 39 years who received health examinations. The subjects were stratified into four age groups (20–24, 25–29, 30–34, and 35–39 years) or into four groups based on the number of risk factors (hypertension, hyperglycemia, dyslipidemia, and hyperuricemia). The relationship between obesity and risk factors and the relationship between obesity and estimated glomerular filtration rate (eGFR) were analyzed. Results  There were no significant differences in eGFR between obese and nonobese groups, except in the male 35–39 years age group. Body mass index (BMI) in both men and women increased with increase in number of risk factors (P < 0.001). Multivariate analysis revealed that hypertension, hyperglycemia, dyslipidemia, and hyperuricemia were independently associated with obesity. Obesity and the risk factors were independently associated with proteinuria. Conclusion  The present study indicated that obesity was an independent risk factor for proteinuria in healthy subjects younger than 40 years of age. The other risk factors were independently associated with obesity. These findings suggest that obesity causes proteinuria concomitantly with other risk factors such as hypertension, diabetes, and dyslipidemia in young adults.     

Systemic Inflammation and Cardiovascular Risk Factors: Are Morbidly Obese Subjects Different?

BACKGROUND: Systemic inflammation is a hallmark of obesity as well as of other chronic diseases, usually indicating increased cardiovascular risk; however, studies with arterial documentation in morbid obesity are extremely scarce. Aiming to analyze correlation between inflammatory markers, pulse-wave velocity (PWV), and intima-media thickness (IMT), a prospective study was designed. METHODS: Morbidly obese patients [n = 29, age 46.3 +/- 5.2 years, 82.8% females (24/29), BMI 44.9 +/- 5.2 kg/m(2)] with C-reactive protein/CRP > 5 mg/l but free from trauma, infection, inflammation, or cancer were enrolled in this study. All were clinically stable candidates for elective bariatric operation. Variables included comorbidities, metabolic profile, inflammatory and coagulatory markers, and arterial morpho-functional indices. RESULTS: Patients suffered from arterial hypertension (72.4%), metabolic syndrome (58.6%), and other comorbidities, but PWV and IMT were less aberrant than expected. Univariate correlation confirmed worse prognosis for those with metabolic syndrome and other accepted clinical risk factors. Multivariate confirmation was achieved for triglycerides (PWV) and D-dimer (IMT), but not for CRP, serum amyloid A, or neutrophil count, which were reversed in certain circumstances. CONCLUSIONS: (1) Metabolic syndrome, hyperglycemia, hypertriglyceridemia and D-dimer were positively correlated with arterial measurements, whereas inflammatory and coagulatory markers often exhibited paradoxical association; (2) stratification confirmed that at certain levels of systemic inflammation or body mass index, acute phase proteins and other markers became unreliable or shifted signals; (3) when controlled for blood pressure, PWV was only moderately elevated, and IMT remained normal; (4) taken together, these findings are consistent with a unique interaction between adiposity, inflammation, and cardiovascular risk in seriously obese subjects.